Quality of survival assessment in European childhood brain tumour trials, for children below the age of 5 years.

The highest incidence rate of childhood brain tumours is in children below the age of five years, who are particularly vulnerable to the effects of treatments. The assessment of quality of survival (QoS) in multiple domains is essential to compare the outcomes for different tumour types and treatment regimens. The aim of this position statement is to present the domains of health and functioning to be assessed in children from birth to five years, to advance the collection of a common QoS data set in European brain tumour trials. The QoS group of the European Society of Paediatric Oncology (SIOP-E) Brain Tumour group conducted consensus discussions over a period of six years to establish domains of QoS that should be prioritised in clinical trials involving children under 5 years. The domains of health and functioning that were agreed to affect QoS included: medical outcomes (e.g. vision, hearing, mobility, endocrine), emotion, behaviour, adaptive behaviour, and cognitive functioning. As for children aged five years and older, a 'core plus' approach is suggested in which core assessments are recommended for all clinical trials. The core component for children from birth to three years includes indirect assessment which, in this age-group, requires proxy assessment by a parent, of cognitive, emotional and behaviour variables and both direct and indirect endocrine measures. For children from four years of age direct cognitive assessment is also recommended as 'core'. The 'plus' components enable the addition of assessments which can be selected by individual countries and/or by, age-, treatment-, tumour type- and tumour location-specific trials.

Neurocognitive effects of CNS tumors.

There is ample evidence that many children treated for brain tumors experience long-term neurocognitive deficits. The severity of those deficits is determined by a complex interaction of the child's genetic make-up and age, neuroanatomical damage caused by tumor and surgery, radiotherapy and chemotherapy, the psychosocial environment, and the intensity of targeted rehabilitation. The consequences of neurocognitive deficits are moderated by the number and severity of other deficits, including neurological and endocrine impairments, and this wider context must be considered. The impact of intellectual decline on academic functioning is evident, and underlies, for example, poor reading, writing, and mathematical skills. The effects of early brain damage on development are cumulative as more functions are expected to mature. Many survivors of CNS tumors can be expected to grow into deficits that have far-reaching consequences not only for academic achievement but also for their psychological and social development and their ability to be self-sufficient. Because the problems typically only become apparent over time, surveillance for their detection is an essential prerequisite for early educational and other interventions to support learning and successful transition to independent adult life.

Empathy as related to creativity, dogmatism, and expressiveness.

Empathy (affective sensitivity) was hypothesized to be positively related to creativity and expressiveness and inversely related to dogmatism, when gender and age were controlled. Participants were 56 graduate students enrolled in counseling and educational psychology courses at a large southwestern (U.S.) university. Participants were administered the Affective Sensitivity Scale (Kagan & Schneider, 1977) to measure empathy, the Statement of Past Creative Activities (Bull & Davis, 1980) to measure creativity, the Opinion Scale (Kleiber, Veldman, & Menaker, 1973) to measure dogmatism, and the Extended Personal Attributes Questionnaire (Spence, Helmreich, & Holahan, 1979) to measure expressiveness. The results of multiple regressions provide support for the hypotheses that empathy is positively related to creativity and inversely related to dogmatism, but the results do not support the hypothesized positive relationship between empathy and expressiveness. Implications of these findings for persons serving as counselors and counselor educators are discussed.